Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.31 / $268.45 / $899.50	Facility		$137.31	$268.45	$899.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $49.65 / $91.92	Facility	26	$32.15	$49.65	$91.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $95.67 / $440.00	Professional		$81.59	$95.67	$440.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.16 / $15.03 / $84.00	Professional	26	$13.16	$15.03	$84.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $78.73 / $132.75	Professional	TC	$67.40	$78.73	$132.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $274.82 / $283.06 / $291.31	Facility		$274.82	$283.06	$291.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.16 / $50.63 / $52.11	Facility	26	$49.16	$50.63	$52.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.90 / $238.92 / $298.64	Professional		$90.90	$238.92	$298.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $34.90 / $43.63	Professional	26	$16.27	$34.90	$43.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $71.77 / $204.01 / $255.01	Professional	TC	$71.77	$204.01	$255.01
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $87.57 / $131.38 / $262.24	Professional		$87.57	$131.38	$262.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.37 / $23.06 / $46.55	Professional	26	$14.37	$23.06	$46.55
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.20 / $110.59 / $206.14	Professional	TC	$73.20	$110.59	$206.14
Medica Facility/Professional Facility Modifier Low / Median / High Price $113.16 / $202.16 / $460.18	Facility		$113.16	$202.16	$460.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $50.63 / $100.00 / $100.00	Facility	26	$50.63	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $90.45 / $146.21 / $687.89	Professional		$90.45	$146.21	$687.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.57 / $20.82 / $150.00	Professional	26	$16.57	$20.82	$150.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $72.23 / $97.54 / $591.79	Professional	TC	$72.23	$97.54	$591.79
Midlands Facility/Professional Facility Modifier Low / Median / High Price $155.00 / $216.33 / $344.16	Facility		$155.00	$216.33	$344.16
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $50.63 / $52.11 / $87.06	Facility	26	$50.63	$52.11	$87.06
Midlands Facility/Professional Professional Modifier Low / Median / High Price $139.00 / $201.67 / $274.52	Professional		$139.00	$201.67	$274.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.41 / $96.96 / $174.84	Professional		$16.41	$96.96	$174.84
United Facility/Professional Professional Modifier Low / Median / High Price $89.08 / $108.54 / $195.66	Professional		$89.08	$108.54	$195.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.99 / $19.98 / $33.85	Professional	26	$15.99	$19.98	$33.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.45 / $89.35 / $151.81	Professional	TC	$74.45	$89.35	$151.81
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $137.13 / $173.60 / $204.20	Professional		$137.13	$173.60	$204.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.78 / $26.30 / $30.90	Professional	26	$20.78	$26.30	$30.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $116.37 / $147.30 / $173.30	Professional	TC	$116.37	$147.30	$173.30